Testing Together (TT) is a public health strategy that occurs when two or more persons who are in or planning to be in a sexual relationship receive HIV testing services together. TT is particularly important because it creates an opportunity for couples to discuss, establish, or revise sexual agreements for their relationship and allows them to prepare a risk-reduction plan based on the HIV status of both partners.
About Testing Together
Testing Together (TT), previously known as Couples HIV Testing and Counseling (CHTC), is a public health strategy that occurs when two or more persons who are in or planning to be in a sexual relationship receive HIV testing services together (including their HIV test results). This service facilitates communication and disclosure of HIV status. It also supports linkage to HIV medical care, pre-exposure prophylaxis (PrEP), and/or other appropriate services.
TT has been used as an HIV testing strategy in Africa for more than 20 years and has improved HIV prevention outcomes on the continent. This approach is aligned with the goals of the National HIV/AIDS Strategyexternal icon and High Impact Prevention, and has the potential to contribute to reduced HIV incidence in the United States.
TT is particularly important because it:
- reduces the burden of sharing one’s HIV-positive status by ensuring provider-assisted mutual disclosure;
- creates an opportunity for couples to discuss, establish, or revise sexual agreements for their relationship;
- allows couples to prepare a risk-reduction plan based on the HIV status of both partners;
- provides a built-in support system, which may aid in linking persons living with HIV to essential care and treatment services, which is important for discordant couples (i.e., one partner is HIV-positive and the other is HIV-negative), for whom antiretroviral therapy (ART) may significantly reduce the risk of transmission;
- supports pre-exposure prophylaxis (PrEP) and condom use, which can help prevent HIV transmission; and
- early diagnosis of HIV infection and linkage to care enables persons with HIV to start treatment sooner, which leads to better health outcomes and longer, healthier lives.
TT requires additional skills in addition to the skills of an individual HIV testing and counseling provider. Dealing with two people—instead of just one—can be challenging, but with proper training and support, TT providers are able to handle the issues that may arise during a typical TT session. Some providers fear that TT will result in violence or break up of a relationship, but there is no evidence that this is the case.
- Introduce TT and obtain concurrence
- Prepare for and conduct rapid HIV test
- Explore couple’s or partners’ relationship
- Discuss HIV risk concerns and reasons for seeking TT
- Discuss the couple’s or partners’ agreement
- Provide initial results and follow protocol for confirmatory
- Develop care, treatment, and prevention plan based on results
- Refer and link to medical care, social and behavioral services
Testing Together Training
Testing Together training is a two-day classroom training intended for persons who offer HIV testing services to couples or manage and support HIV testing programs. The training:
- reviews essential couple communication skills;
- provides detail on the eight steps for providing a TT session; and
- equips HIV testing providers with the skills, confidence, and tools (including job aids, implementation manual, and sample documents) to deliver this approach for HIV testing with couples.
Because TT builds on the skills of individual HIV testing providers, it is recommended that TT trainees have been previously trained in individual HIV testing according to their local or state jurisdiction’s training requirements. It is also recommended that trainees have provided HIV testing for at least six months or to at least 50 individuals.
There is a 2 hour online pre-course module that is a prerequisite for the classroom training that provides basic information about the TT approach.
There is a 2.5 hour online course designed for healthcare providers, their supervisors or clinic managers, and other persons involved in HIV testing in a healthcare setting who want an overview of TT that offers continuing education (CE).
To view and register for scheduled classroom trainings:
- Access the National HIV Classroom Learning Center training calendarexternal icon hosted on Cicatelli Associates, Inc.’s (CAI’s) website.
- Pre-register for your selected course via the link provided in the training calendar.
- Complete your registration on CDC TRAINexternal icon as directed when you receive an email from the National HIV Classroom Learning Center. You must join the HIV CBA Learning Group and locate the HIV CBA Training Plan in order to complete your CDC TRAIN registration for a specific classroom session (step-by-step instructionspdf iconexternal icon are available).
To access eLearning modules, including classroom training prerequisite courses:
- Log-in to CDC TRAINexternal icon and access the HIV CBA Training Plan (step-by-step instructionspdf iconexternal icon are available).
- Select the module you wish to take.
- Launch the module or save the module for later.
To request that a classroom training be scheduled:
- CDC’s directly funded health department and CBO partners may request delivery of a CDC-supported training by submitting a request in the CBA Tracking System.
- Organizations not directly funded by CDC may contact their local health department for assistance in submitting a training request.
Implementation and Marketing Materials
The materials and resources listed below support the implementation and/or marketing of Testing Together by health departments, community-based organizations, and health care or other organizations. The resources are evidence-based and designed for cost-effective, scalable implementation.
- Curran K, Baeten JM, Coates TJ, Kurth A, Mugo NR, Celum C. HIV-1 prevention for HIV-1 serodiscordant couples. Curr HIV/AIDS Rep. 2012;9(2):160-170.
- Allen S, Meinzen-Derr J, Kautzman M, Zulu I, Trask S, Fideli U, Musonda R, Kasolo F, Gao F, Haworth A. Sexual behavior of HIV discordant couples after HIV counseling and testing. AIDS 2003;17(5):733-740.
- Dunkle KL, Stephenson R, Karita E, Chomba E, Kayitenkore K, Vwalika C, Greenberg L, Allen S. New heterosexually transmitted HIV infections in married or cohabiting couples in urban Zambia and Rwanda: An analysis of survey and clinical data. Lancet 2008;371(9631):2183-2191.
- Centers for Disease Control and Prevention (CDC). High-Impact HIV Prevention – CDC’s Approach to Reducing HIV Infections in the United States pdf icon[PDF – 400 KB]. August 2011.
- El-Bassel N, Gilbert L, Witte S, Wu E, Hunt T, Remien RH. Couple-based HIV prevention in the United States: Advantages, gaps, and future directions. J Acquir Immune Defic Syndr 2010;55 Suppl 2:S98-101.
- HIV Surveillance Report pdf icon[PDF – 86 KB], 2010; vol. 22. Published March 2012.
- Sullivan PS, Salazar L, Buchbinder S, Sanchez TH. Estimating the proportion of HIV transmissions from main sex partners among men who have sex with men in five U.S. cities. AIDS 2009;23(9):1153-1162.
- Were E, Curran K, Delany-Moretlwe S, Nakku-Joloba E, Mugo NR, Kiarie J, Bukusi EA, Celum C, Baeten JM; Partners in Prevention HSVHIV Transmission Study Team. A prospective study of frequency and correlates of intimate partner violence among African heterosexual HIV serodiscordant couples. AIDS 2011;25(16):2009-2018.
- Grinstead OA, Gregorich SE, Choi KH, Coates T; Voluntary HIV-1 Counselling and Testing Efficacy Study Group. Positive and negative life events after counseling and testing: The Voluntary HIV-1 Counseling and Testing Efficacy Study. AIDS 2001;15(8):1045-1052.